presentations on literature review

The Cersonsky Lab at UW-Madison

The Cersonsky Lab is a research group based at the University of Wisconsin - Madison, Department of Chemical and Biological Engineering

8 Tips for a Literature Review Presentation

by Caleb Youngwerth

Literature reviews for research are very different from any other presentation you may have done before, so prepare to relearn how to present. The goals of research literature reviews are different, the style is different, even the pacing is different. Even if you have previously done a literature review in an academic setting, you will still want to know these tips. I found this out the hard way, so you don’t have to. Also, to clarify, these tips are meant for a literature review of a topic, not a singular study or paper, though many of the tips do apply to both.

1. Highlight current research

The point of a literature review for research is to highlight the current state of research related to your topic, not to simply give background information. Background information is important and should be included, but the focus of the presentation should be showing some current studies that either confirm or challenge the topic you are studying. As much as textbooks from 30 years ago might seem to have all the information you need for your presentation, a research study from this decade does a far better job representing the current state of the topic, which is the end goal of the presentation. Also, since the new research should be the focal point of the presentation, as a general piece of advice, try to give each research study a minimum of one full slide, so you can give a fuller picture of what the study actually concluded and how they reached their conclusion.

2. Alternate old and new

The best way to keep people listening to your presentation is to vary what you include in your presentation. Rather than trying to give all of the background information first and then showcase all the flashy new research, try to use the two interchangeably. Organize the presentation by idea and give all the background needed for the idea, then develop the idea further by using the new research studies to help illustrate your point. By doing this, you not only avoid having to backtrack and reteach the background for each and every new study, but also help keep the presentation interesting for the audience. This method also helps the audience avoid being overwhelmed since only a little bit of new information is introduced at a time. Obviously, you may need to include a brief introductory section that contains nothing but textbook information that is absolutely necessary to understand anything about the topic, but the more varied the presentation, the better.

3. Use complete sentences

Every presentation class up to this point probably has taught you that slides with full sentences are harmful to your presentation because it is distracting to the listener. Unlearn all that information for this style of presentation. Bullet points are still good, but you should have complete ideas (which usually means complete sentences) for every single point. If someone would be able to read your slides and not hear you, and still be able to understand most of your presentation, your literature review is perfect in a research setting. The point of this presentation is to share all the new information you have learned, so hiding it is helping no one. You still do not want to be reading your slides verbatim and can absolutely add information beyond the slides, but all your main ideas should be on the slides.

4. Read smart

I will admit that I stole this tip from Rosy, but it is a very good tip, so I decided to include it. When you read, you want to read as much as you can, but wasting time reading an irrelevant research study is helping no one. When finding a new study, read the abstract, then the conclusion, then the pictures. If it looks like a good study from those three parts, or you personally find it interesting, you then can go over the actual paper and read it, but by reading the less dense parts first, you can get a general idea of the study without actually having to take a lot of time to read the entire paper. Though textbooks and review papers generally are a little more difficult to read using this method, you can still look at the introduction, pictures, and conclusion and save time reading the rest if the source ends up not being interesting or important.

5. Reading is good for you

As much as you want to read smart when you can, the more you read, the more knowledgeable you become. The goal of the presentation is to become an expert on you topic, so the only way you can do that is by reading as much as you can. You should read more information than you present, since many sources you read probably will not fit in a time-constrained presentation. As Rosy likes to say, in anything research, only about 10% of what you know should actually be shared with the world. By reading more, you are better-suited to answer questions, and you also just generally are able to understand what you are studying better because, chances are, the main purpose of this presentation for you is to help you better understand your research. If something looks interesting and is vaguely related to your topic, read it; it will be beneficial to you, even if you do not end up presenting the information.

6. Let pictures talk for you

When reading research papers, the pictures are usually the best part. Your presentation should be the same way. The best way to be able to show the concept you are trying to explain is to literally show it. The best way to show the results of a research study is usually by showing a graph or infographic, so if the paper has a graph that shows the results, you should absolutely use it. Charts, diagrams, and even videos can also help illustrate a piece of background information that might be difficult to put into words. That being said, you should know and be able to explain every single part of the graphic. Otherwise, it loses meaning and makes the audience even more confused. Captions can and should be used to help explain the graphic, not only to remind you, but also let your audience know what the general idea of the graphic is. Since they keep slides interesting, you should probably have some sort of picture on every slide, otherwise the slides will be not only bland, but also likely less informative.

7. Avoid overcrowded slides

Just because you should have a lot of information in your presentation does not mean that your slides need to show that. In fact, a slide with too much information will only harm your presentation since your audience will be distracted trying to read all of a long slide while you are trying to explain it. Doing anything to make slides less dense will help avoid having the audience focused on the slide, so they focus on you more. Transitions that only show one point at a time or wait to reveal an image can be helpful in breaking up an overcrowded slide. Also, simply adding more slides can help since it accomplishes the purpose of putting less information on your slides while still keeping the exact same amount of information. You still want to share as much information as you can with the audience, but overcrowded slides do not accomplish this purpose.

8. Expect questions

Another thing that might be slightly different about a research presentation is questions. Most presentations have the question section after the presenter has finished. Research presentations are different because they allow for questions during the presentation (assuming it is a presentation to a small group). If you get any questions in the middle of the presentation, it is not someone being rude, but simply a fellow researcher who is legitimately curious about your topic. Of course, there will be a question period after the presentation, but you may be asked questions during the presentation. If you read enough information on the topic, you should be able to answer any question easily, but if the question is completely unrelated to anything you read, then it is perfectly reasonable to answer that you did not research the specific area in question. Overall, the questions related to your presentation should not be your biggest worry, but you should definitely be ready.

These are not all the rules for a literature review presentation nor are they set in stone. These are just some tips that I was told or learned that were the most helpful for me, so I hope they will help you too. I had to rewrite my presentation entirely my first literature review because I did not understand some of these differences, so if you give the presentation when you are scheduled to go, you are already better off than I was. Also, do not be afraid to ask anyone in the research group, even Rosy, if you need help. Chances are everyone in the group has given a literature review presentation at some point, so we would be more than happy to help you if you are confused about something. That being said, we are not experts on your topic, so specific questions about organization and content are going to have to be figured out by yourself. Either way, no matter what you do, do not stress out about this presentation. The goal of the presentation is mostly just to help improve your knowledge on a topic, and the presentation is simply to share with the group some of the information you have learned. Best of luck with the presentation, and I hope these tips help clear up what exactly the goal of a literature review presentation in a research setting is.

DEAN’S BOOK w/ Prof. CONNIE GRIFFIN

Honors291g-cdg’s blog, literature review/poster presentation guide.

Literature Review & Poster/Visual Presentation Guide GIVING & GETTING EFFECTIVE PRESENTATIONS PRESENTATIONS In many disciplines presentations are given at academic conferences, symposia, and other places where scholars share their work with one another (including the Massachusetts Undergraduate Research Conference).  It can be very challenging to display and communicate all of one’s research findings in a synthesized manner and short timeframe.  Following are some thoughts about both preparing your presentation and also how to maximize your experience as an audience member. I. PRESENTER’S ROLE: The overall purpose of your presentation is to share your research process and findings with the class. In all cases, whatever topic you choose for your research, the objective is to stimulate in your listeners an understanding of that topic and how you went about developing that understanding for yourself as a researcher. The purpose of your talk is to present your research. Keep that goal in mind as you consider what to include and how to organize it.. In the visual portion of your presentation, be sure to include the following:

1)    Title 2)    Your research question 3)    Examples of what you found (results) including a.    Visual and quantitative information b.    Important quotes 4)    Your conclusion

Remember to keep your presentation (and your visual material) concise. It is very easy to overwhelm an audience with too much text.  Also, be sure to use a font size that is large enough to read from several feet away. Presentation considerations. Five minutes go fast! Therefore, stick with the most important points (details can come in the Q&A session), and be sure to organize your presentation logically. Be sure to practice. Nothing will prepare you better than giving your presentation several times to an audience. Speak slowly, clearly, expressively. Make eye contact. Also make sure your visual really does support your oral presentation and aid your audience! Concluding your presentation. End your presentation with a quick summary or suggestion of what’s been gained by your research.  Then be prepared for questions. Be ready with a question of your own in case the audience needs prompting. A crucial part of your presentation is thinking about how to engage the audience. Listen closely, be sure you understand each questioner’s intent, and then answer as directly as possible. II. AUDIENCE’S ROLE: Even when not presenting, you play a crucial role in the presentation and determining its quality.  As a listener, demonstrate your interest: make eye contact with the presenter as you listen closely, and take notes so you can ask informed, pertinent, and helpful questions during the Q&A period. Putting a presenter at ease can go a long way to ensuring an effective presentation.

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Literature Review

Literature review presentation, free google slides theme, powerpoint template, and canva presentation template.

Whether you're a student or an academic, mastering the literature review is a key skill in scholarly writing. This fully customizable Google Slides and PowerPoint template can assist you in structuring your review seamlessly. Featuring a vibrant yellow design with captivating book illustrations, this template is designed to facilitate the organization and presentation of your research. Navigate your audience through chapters, themes, and references with ease and clarity using this versatile academic tool. Utilize this tool to craft an impressive literature review that leaves a lasting impression!

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• 100% editable and easy to modify
• 35 different slides to impress your audience
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• Includes 500+ icons and Flaticon’s extension for customizing your slides
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• Includes information about fonts, colors, and credits of the resources used

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How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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27 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

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What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Literature Reviews

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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

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For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

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Literature Review: Introduction and Notes

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Literature review IBC 464

Literature Review Taken From: University of Washington Psychology Writing Center.

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What is a thematic literature review?

Advantages of a thematic literature review, structuring and writing a thematic literature review.

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A thematic literature review serves as a critical tool for synthesizing research findings within a specific subject area. By categorizing existing literature into themes, this method offers a structured approach to identify and analyze patterns and trends across studies. The primary goal is to provide a clear and concise overview that aids scholars and practitioners in understanding the key discussions and developments within a field. Unlike traditional literature reviews , which may adopt a chronological approach or focus on individual studies, a thematic literature review emphasizes the aggregation of findings through key themes and thematic connections. This introduction sets the stage for a detailed examination of what constitutes a thematic literature review, its benefits, and guidance on effectively structuring and writing one.

A thematic literature review methodically organizes and examines a body of literature by identifying, analyzing, and reporting themes found within texts such as journal articles, conference proceedings, dissertations, and other forms of academic writing. While a particular journal article may offer some specific insight, a synthesis of knowledge through a literature review can provide a comprehensive overview of theories across relevant sources in a particular field.

Unlike other review types that might organize literature chronologically or by methodology , a thematic review focuses on recurring themes or patterns across a collection of works. This approach enables researchers to draw together previous research to synthesize findings from different research contexts and methodologies, highlighting the overarching trends and insights within a field.

At its core, a thematic approach to a literature review research project involves several key steps. Initially, it requires the comprehensive collection of relevant literature that aligns with the review's research question or objectives. Following this, the process entails a meticulous analysis of the texts to identify common themes that emerge across the studies. These themes are not pre-defined but are discovered through a careful reading and synthesis of the literature.

The thematic analysis process is iterative, often involving the refinement of themes as the review progresses. It allows for the integration of a broad range of literature, facilitating a multidimensional understanding of the research topic. By organizing literature thematically, the review illuminates how various studies contribute to each theme, providing insights into the depth and breadth of research in the area.

A thematic literature review thus serves as a foundational element in research, offering a nuanced and comprehensive perspective on a topic. It not only aids in identifying gaps in the existing literature but also guides future research directions by underscoring areas that warrant further investigation. Ultimately, a thematic literature review empowers researchers to construct a coherent narrative that weaves together disparate studies into a unified analysis.

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Conducting a literature review thematically provides a comprehensive and nuanced synthesis of research findings, distinguishing it from other types of literature reviews. Its structured approach not only facilitates a deeper understanding of the subject area but also enhances the clarity and relevance of the review. Here are three significant advantages of employing a thematic analysis in literature reviews.

Enhanced understanding of the research field

Thematic literature reviews allow for a detailed exploration of the research landscape, presenting themes that capture the essence of the subject area. By identifying and analyzing these themes, reviewers can construct a narrative that reflects the complexity and multifaceted nature of the field.

This process aids in uncovering underlying patterns and relationships, offering a more profound and insightful examination of the literature. As a result, readers gain an enriched understanding of the key concepts, debates, and evolutionary trajectories within the research area.

Identification of research gaps and trends

One of the pivotal benefits of a thematic literature review is its ability to highlight gaps in the existing body of research. By systematically organizing the literature into themes, reviewers can pinpoint areas that are under-explored or warrant further investigation.

Additionally, this method can reveal emerging trends and shifts in research focus, guiding scholars toward promising areas for future study. The thematic structure thus serves as a roadmap, directing researchers toward uncharted territories and new research questions .

Facilitates comparative analysis and integration of findings

A thematic literature review excels in synthesizing findings from diverse studies, enabling a coherent and integrated overview. By concentrating on themes rather than individual studies, the review can draw comparisons and contrasts across different research contexts and methodologies . This comparative analysis enriches the review, offering a panoramic view of the field that acknowledges both consensus and divergence among researchers.

Moreover, the thematic framework supports the integration of findings, presenting a unified and comprehensive portrayal of the research area. Such integration is invaluable for scholars seeking to navigate the extensive body of literature and extract pertinent insights relevant to their own research questions or objectives.

The process of structuring and writing a thematic literature review is pivotal in presenting research in a clear, coherent, and impactful manner. This review type necessitates a methodical approach to not only unearth and categorize key themes but also to articulate them in a manner that is both accessible and informative to the reader. The following sections outline essential stages in the thematic analysis process for literature reviews , offering a structured pathway from initial planning to the final presentation of findings.

Identifying and categorizing themes

The initial phase in a thematic literature review is the identification of themes within the collected body of literature. This involves a detailed examination of texts to discern patterns, concepts, and ideas that recur across the research landscape. Effective identification hinges on a thorough and nuanced reading of the literature, where the reviewer actively engages with the content to extract and note significant thematic elements. Once identified, these themes must be meticulously categorized, often requiring the reviewer to discern between overarching themes and more nuanced sub-themes, ensuring a logical and hierarchical organization of the review content.

Analyzing and synthesizing themes

After categorizing the themes, the next step involves a deeper analysis and synthesis of the identified themes. This stage is critical for understanding the relationships between themes and for interpreting the broader implications of the thematic findings. Analysis may reveal how themes evolve over time, differ across methodologies or contexts, or converge to highlight predominant trends in the research area. Synthesis involves integrating insights from various studies to construct a comprehensive narrative that encapsulates the thematic essence of the literature, offering new interpretations or revealing gaps in existing research.

Presenting and discussing findings

The final stage of the thematic literature review is the discussion of the thematic findings in a research paper or presentation. This entails not only a descriptive account of identified themes but also a critical examination of their significance within the research field. Each theme should be discussed in detail, elucidating its relevance, the extent of research support, and its implications for future studies. The review should culminate in a coherent and compelling narrative that not only summarizes the key thematic findings but also situates them within the broader research context, offering valuable insights and directions for future inquiry.

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A literature review in research is a critical and systematic analysis of existing literature, scholarly articles, books, and other relevant sources that are pertinent to a particular research topic or question. Incorporating a literature review in research is essential for contextualizing the study within existing knowledge, identifying research gaps, and guiding the research design and This Presentation simplifies complex ideas, making your presentation both engaging and informative. This Presentation is explain detailed with Literature images. This template is fully created by green based theme. The template empowers you to concisely convey the essence of your literature review, capturing attention and fostering understanding. This Presentation is fully customized and It is used for researchers, academics, students, and professionals engaged in various fields of study.

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LITERATURE REVIEW

Jul 22, 2014

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LITERATURE REVIEW. 2.1What is a “Literature Review”?. A literature review is an overview of research on a given topic and answers to related research questions Literature reviews are an important part of research and should be treated as such A well-written literature review:

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2.1What is a “Literature Review”? • A literature review is an overview of research on a given topic and answers to related research questions • Literature reviews are an important part of research and should be treated as such • A well-written literature review: • Organizes literature • Evaluates literature • Identifies patterns and trends in literature • Synthesizes literature

‘the literature’ means the works you consulted in order to understand and investigate your research problem. • A literature review involves providing a rationale for your selection of literature related to the subject studied.

The literature review familiarizes the reader with the subject and the scope of the research topic. • It helps the reader to define key concepts • Finally it establishes the body of knowledge which will be able to contribute towards the research.

2.2 Writing the Literature Review • Firstly decide what you need to read from a broad spectrum of literature available • Refer to books, periodicals, journals, and websites which will be relevant to your study.

Determine what exactly are your objectives • Provide a current and complete overview of your related topic. • Show that you have read extensively and formed a body of knowledge on the subject of field of study

Purpose of writing a literature Review Your review should be in a form of • critical decision, • showing awareness of differing arguments, theories, approaches and methodologies. It should be a synthesis and analysis of the relevant published work, linked at all times to your objective and rationale of your study.

There are several purposes on why we write a literature review: • it reviews knowledge of previous studies on the subject of research • it identifies a conceptual framework for own research • it provides directions for future research • it provides resources previously unknown to the reader • it identifies gaps in past studies

To sum up, a good literature review is: • critical of what has been written, • identifies areas of controversy, • raises questions and identifies areas which need further research.

2.3 Process of Writing a Literature Review • There are several stages in developing a literature review(Biddlek, 1997). The stages are : • Identify • Record • Relevance • Retrieve • Review • Write

Stage 1 – Identify • Compile a list of references. • Use a kind of index system either a hard copy or a software referencing system. • i)work through key catalogues, databases, indexes, bibliographies and websites for relevant resources • ii)check the references and in the articles you have read • iii)locate and use research reviews

Stage 2-Record • Make a record of any literature that relates to your topic. • You should have citation details, where it is located, and should also write a few sentences that help you remember what the article is about

Stage 3 –Relevance • i)Prioritize the literature, after having read the abstract, rank them if it should be high, medium or low priority • ii)On the website scan through the literature for relevance before you decide to download or print it out • iii) You need to focus on the literature and sources you have identified and ranked as most important, the most recent development from the periodicals. • iv) Distinguish between textbooks and research articles from journals and books. They contain different kinds of information that will be more or less relevant to your research

Stage 4 -Retrieve • i) Make hard copies of the most important literature. Print relevant journal articles from databases and photocopy articles from journals

Stage 5 –Review • Use the reading log which allows you to record different kinds of information: the bibliographic details, a description, and relationship to other readings. • Also record where the literature is located so that you can easily refer to the quotes or ideas paraphrased when you are editing. • As you are taking notes, ensure you are clear about what you are quoting and paraphrasing. You cannot risk unintentionally plagiarizing ideas.

Stage 6 -Write • Start with an introductory paragraph • Discuss the literature on the subject in a logical and coherent way • Conclude with a paragraph that is relevant to the literature of the research

2.4 Five Phases of Writing a Literature Review • Phase 1 – Specify the scope of your review • i)Ensure you have a precise topic • you must be precise about having a topic. It should not be too broad or unspecific. Look at the following topic which is too broad • Example: ‘Life and Times of Sigmund Freud” • The title below seems to be limited, but still considered too broad • Example: “Psychological Theories of Sigmund Freud • However, a more manageable and appropriate topic would be • ‘Freud’s Theory of Personality Applied to Mental Health” • If your research question is too broad or defined vaguely or abstractly, you may end up reading and compiling too much information for your literature review. However if your research question is specified too narrowly or defined concisely, you may miss out more general information

ii)Scope of the Literature Review You have to determine the precise scope of the literature review. Questions which need to be answered are as follows :- • What will I cover in my review? • How comprehensive will it be? • How current are my materials? • What type of materials/documents will be needed?

Phase 2: Locating and Accessing Information • Obtain all the necessary materials for your literature review by searching relevant bibliographies, print indexes and online databases i)Using Existing Literature Reviews • Many journals on different subject areas publish review articles. In these journals you may find commentaries on research articles. You may find these reviews relevant to your literature review.

Phase 3 Recording the Information • You can develop a systematic way of recording information through: note cards with citations • Photocopied articles with points highlighted or underlined with notes in the margins • Traditional taking down notes or in laptops

i)Tips on Recording Information • A quick skimming and scanning through the introduction and the conclusion of an article, would give you an idea of the article and general points. • a)Start with the most recent studies and work backwards. Refer to the list of references on a recent article;   • b)Read, first the report or article’s abstract - this will give you some clues about the article • c)When taking down notes, remember to write out the complete bibliographic citation for each work. It is essential you note down the page numbers as these will be necessary later for footnotes and bibliography. For internet citations note the URL • d)Write all direct quotations precisely when taking down notes. You should use quotations marks, so it can recognize as a directly quoted text and not a paraphrase. If you fail to put a direct text in quotation marks or to credit the authors, it amounts to plagiarism.

Phase 4 Evaluating the Information • After having read all the articles, you must now decide and evaluate what should be included in the review. • Be selective - you have to consider issues and themes that link different articles.

Phase 5 Organizing and Writing the Literature Review • After accessing, reading and evaluating the material, these materials need to be organized. • You may organize the selected readings by theoretical approaches, by specific concepts or issues, and by methodologies

Some tips on writing After you have located, read, analyzed and evaluated the literature, the next stage is actual writing. Here are some tips: • Keep your paragraphs short • Subheadings are essential, as it clarifies the structure. They break up the materials into more readable units • Avoid too many long direct quotations from the studies. Paraphrase other writers’ works rather than quote lengthy passages • Don’t cite references that you haven’t read

Some traps to avoid • Trying to read everything! • not to provide a summary of all the published work that relates to your research, but a survey of the most relevant and significant work. • Reading but not writing! • Writing can help you understand and find relationships between the work you’ve read, so don’t put writing off until you’ve “finished” reading. • Not keeping bibliographic information! - Source: http://www.clpd.bbk.ac.uk/students/litreview web.pdx.edu/~bertini/literature_review.pdf

Final Checklist Here is a checklist from University of Melbourne: (http://www.lib.unimelb.eduau/postgrad/litreview/finalchecklist.html) • Have you indicated the purpose of the review? • Have you ascertained the parameters of the review and are they reasonable? • Have you emphasized on recent development of the research? • Have you focused on primary sources with only selective use of secondary sources? • Is the literature selected relevant to your study? • Is your bibliographic data complete?

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• Published: 27 April 2024

Minimally invasive treatment of uterine necrosis with favorable outcomes: an uncommon case presentation and literature review

• Tengge Yu 1  

BMC Women's Health volume  24 , Article number:  267 ( 2024 ) Cite this article

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Metrics details

Uterine necrosis is a rare condition and is considered a life-threatening complication. However, cases of uterine necrosis were rarely reported, particularly those caused by infection. In terms of treatment, no minimally invasive treatment for uterine necrosis has been reported, and total hysterectomy is mostly considered as the treatment option.

The article specifically focuses on minimally invasive treatments and provides a summary of recent cases of uterine necrosis.

Case presentation

We report the case of a 28-year-old patient gravid 1, para 0 underwent a cesarean section after unsuccessful induction due to fetal death. She presented with recurrent fever and vaginal discharge. The blood inflammation markers were elevated, and a CT scan revealed irregular lumps with low signal intensity in the uterine cavity. The gynecological examination revealed the presence of gray and white soft tissue, approximately 5 cm in length, exuding from the cervix. The secretions were found to contain Fusobacterium necrophorum, Escherichia coli, and Proteus upon culturing. Given the patient’s sepsis and uterine necrosis caused by infection, laparoscopic exploration uncovered white pus and necrotic tissue openings in the anterior wall of the uterus. The necrotic tissue was removed during the operation, and the uterus was repaired. Postoperative pathological findings revealed complete degeneration and necrosis of fusiform cell-like tissue. Severe uterine necrosis caused by a multi-drug resistant bacterial infection was considered after the operation. She was treated with antibiotics for three weeks and was discharged after the infection was brought under control. The patient expressed satisfaction with the treatment plan, which preserved her uterus, maintained reproductive function, and minimized the extent of surgery.

Based on the literature review of uterine necrosis, we found that it presents a potential risk of death, emphasizing the importance of managing the progression of the condition. Most treatment options involve a total hysterectomy. A partial hysterectomy reduces the extent of the operation, preserves fertility function, and can also yield positive outcomes in the treatment of uterine necrosis, serving as a complement to the overall treatment of this condition.

Peer Review reports

Uterine necrosis is a rare complication. Several cases of uterine necrosis have been reported following embolization of the uterine arteries for postpartum hemorrhage or uterine fibroids, or as a result of severe endometritis [ 1 ]. Symptoms of uterine necrosis caused by infection typically include lower abdominal pain, fever, and foul-smelling vaginal discharge. When the infection affects the tissue surrounding the uterus, the uterus becomes enlarged and tender, and the edema of the inflamed tissue holds the uterus in place. Some complications may occur infrequently, including peritonitis, pelvic vein thrombosis, pulmonary embolism, pelvic abscess, sepsis, kidney damage, and even death. Diagnosis is usually based on clinical symptoms and physical examination. Inflammatory markers, imaging studies, and secretion cultures can also assist in the diagnosis. Hysteronecrosis is typically treated with a total hysterectomy. Most patients recover, and only a small number of patients do not survive. We reported a case of uterine necrosis caused by infection. We removed part of the uterus instead of performing a total hysterectomy. The patient recovered well. Few cases of uterine necrosis have been reported, and no one has reported minimally invasive treatment for it. Given the rarity of the case and the lack of minimally invasive treatment options for uterine necrosis, this report was written in conjunction with a literature review summarizing similar cases of uterine necrosis.

We report the case of a 28-year-old patient who was gravid 1, para 0, with no significant medical history. The patient is Asian, from the Han ethnic group, China’s largest ethnic group. When she was 32 weeks pregnant, intrauterine fetal demise was confirmed by ultrasound. A cesarean section was performed due to the difficulty of vaginal trial labor following a lateral perineal incision, which was necessary because the fetus’s shoulder was exposed. After the operation, the patient continued to experience a high fever, with a maximum temperature of 39.5 degrees Celsius, and the fat around the abdominal incision has become liquefied. The number of patient’s pulses was 140, respiratory rate was 22 times per minute, and blood pressure was 131/87mmhg. After receiving treatment with medications such as Tienam and Piperacillin, the patient’s body temperature and inflammation returned to normal, and she was discharged from Municipal integrated traditional Chinese and Western medicine hospital. The type of antibiotic Tienam is Carbapenem antibiotics, and the dose is 500 mg by injection three times a day. The type of antibiotic Piperacillin is semi-synthetic penicillin antibiotics, and the dose is 1.5 g by injection three times a day. The disease subside after 7 days treatment.

A week later, she was admitted to Municipal integrated traditional Chinese and Western medicine hospital for the second time due to fever and pain in her lower left abdomen. The patient’s heart rate was normal, respiratory rate was 20 times per minute, and blood pressure was 121/80mmhg. The blood inflammation index was elevated, indicated by a C-reactive protein level of 52.01 mg/L. Brain CT and lung CT scans revealed no significant abnormalities. She was discharged after two weeks of treatment with medications such as Tienam and Piperacillin with the same dose as last time. The disease subside after 5 days treatment.

Five days later, she was admitted to our hospital for the third time due to a recurring fever, accompanied by vaginal purulent discharge and odor. The patient’s heart rate was 110 times per minute, respiratory rate was 23 times per minute, and blood pressure was 132/85mmhg. There was no increase in β-HCG, white cell count was 12.3 × 10^9 /L in the differential blood count, hemoglobin was 104 g/L, and procalcitonin was 0.12 ng/ml. She felt feverish and lethargic, with mild nausea. The patient was treated orally with Moxifloxacin by 1 tablet once a day for 3 days. A vaginal color ultrasound revealed a hypoechoic area in front of the uterus, indicating encapsulated effusion. The ultrasound also revealed an abnormal uterine echo, uneven uterine enlargement with abundant blood supply, trace effusion of the cervical canal, and pelvic effusion. The enhanced CT scan revealed swelling and adhesion of the anterior wall of the uterus and the adjacent anterior abdominal wall, along with changes in the surrounding exudate. Additionally, a lumpy, uneven low signal shadow was observed in the uterine cavity, along with visible pelvic fluid (Fig.  1 ). The histopathological analysis of intrauterine effluents revealed degenerative smooth muscle tissue accompanied by pus. Anaerobic culture of cervical secretions suggested the presence of Fusobacterium necrophorum. Biopsy of cervical and vaginal lesions revealed complete necrosis of fusiform cell-like tissue, with increased infiltration of inflammatory cells, and no identifiable endometrial tissue. Due to the presence of pus in the uterus, morinidazole was administered, and uterine drainage was performed. However, the result was not favorable. A gynecological examination revealed the presence of necrotic tissue in the vagina, extending approximately 5 cm from the cervical opening. The tissue appeared white and emitted a foul odor. It was recommended to undergo a laparoscopic surgery.

Sagittal computed tomography images. The uterus shows heterogeneous spongiform enlargement with multiple air locules, measuring 4 × 2.6 cm and extending over 5 cm. We have observed a difficulty in distinguishing between the myometrium and the endometrial cavity

Given that the patient had strong fertility requirements, the surgical procedure included laparoscopic necrotic tissue excision, uterine reconstruction, and the uterine drainage tube placement. During the laparoscopy, adhesion of the uterus to the anterior wall of the abdomen was observed. An opening with white pus and necrotic tissue was visible in the anterior wall of the uterus. The necrotic tissue in the cavity was removed during the operation (Fig.  2 Fig.  3 ). Cefoxitin (1.5 g tid ivgtt) and ornidazole (500 mg bid oral) were administered postoperatively to prevent infection for 2 days. After the surgery, the patient developed a fever with a peak body temperature of 39.3 degrees Celsius, which prompted a switch to cefoperazone-sulbactam sodium (2 g bid ivgtt) and ornidazole antibiotics (500 mg bid oral) for 7 days. After the body temperature returned to normal, the antibiotics were downgraded, the uterine drainage tube was removed, and oral antibiotics were continued after discharge. The results of the vaginal secretion culture indicated the presence of Escherichia coli and Proteus bacteria. The pathological results revealed extensively denatured necrotic tissue with calcification and heightened inflammatory cell infiltration.

The images seen during the surgery. The necrotic tissue of the uterus, attached to the anterior wall of the abdomen, is clearly visible in gray and white colors. It is situated in the anterior wall of the uterus and is connected to the uterine cavity

The gross specimen appeared gray in color, with an extremely soft texture, measuring about 5 cm in length, and accompanied by a foul odor

Uterine necrosis is a rare and serious complication. Cases of uterine necrosis have been reported in the literature as a complication of cesarean section, embolization for postpartum hemorrhage, or for a leiomyomatous uterus, as well as in cases of severe endometritis [ 2 , 3 , 4 , 5 , 6 , 7 ] (Table  1 ). Several authors have described cases of uterine necrosis associated with intrapartum or postpartum complications that increase the risk of infection. The literature reports cases of uterine necrosis resulting from the placement of B-Lynch compression sutures, uterine artery embolization, or surgical ligation techniques used to treat postpartum hemorrhage. These procedures may increase the risk of infection as the tissue becomes devascularized. A. Fouad et al. described a case similar to ours in which a patient underwent a cesarean section due to fetal death, followed by postoperative sepsis and purulent uterine necrosis. Despite undergoing a hysterectomy, the disease continued to progress and ultimately resulted in death due to septic shock and multiple organ failure.

The case we report has identified pathogenic bacteria in the culture, which is significant for diagnosing infection-induced uterine necrosis. Fusobacterium necrophorum is a pleomorphic, Gram-negative, non-spore-forming obligate anaerobic coccobacillus. It is associated with localized abscesses, throat infections, and life-threatening systemic diseases. It is a common resident of the oral cavity and the vagina. Of the two subspecies of Fusobacterium necrophorum, biovar B is the primary pathogen for humans. Potential virulence factors include cell wall endotoxin lipopolysaccharide, hemagglutinin, and hemolysin. Most reported cases related to gynaecology occurred in the postpartum or post-abortion period, in addition to a few reports associated with the use of intrauterine devices, tubo-ovarian abscesses, and gynecological Lemierre’s syndrome [ 8 , 9 , 10 ]. Although infected with the same pathogen, the case reported by T. Widelock et al. developed more severe symptoms, including lung abscesses and kidney failure, as a result of hematoplasm infection [ 11 , 12 , 13 ].

A pelvic ultrasound is the initial diagnostic test that can reveal signs of uterine necrosis. The uterine cavity is typically expanded and exhibits multiple echogenic foci with accompanying dirty acoustic shadowing. Little or no vascularity is observed [ 14 ]. The diagnosis requires further exploration through a CT scan or MRI, as these are the preferred methods of investigation. The CT scan is highly useful for diagnosis as it demonstrates the presence of gas in the myometrium, the lack of enhancement of the myometrium after contrast injection associated with uterine enlargement, and the presence of free fluid in the peritoneal space [ 15 , 16 ].

Since uterine necrosis is described as a life-threatening complication, it is suggested to manage it with hysterectomy and broad-spectrum antibiotic therapy [ 17 , 18 ]. But sometimes it’s a case-by-case situation.

Avoid the chances of associated infections by systematic vaginal sampling in the third trimester, and promote good asepsis during surgery and antibiotic coverage in case of doubt about any undiagnosed prepartum infection, which may potentiate hypoxia and the risk of necrosis. Uterine necrosis may be secondary to all these intertwined factors and could be potentiated by an environment of hypoxia, hypoperfusion, hypovolemia secondary to hemorrhage, massive transfusions with disadvantages in a patient who is immunocompromised by pregnancy, and possibly, by other vitamin and iron deficiencies.

Given the limited number of reported cases of uterine necrosis in the past, there is no standardized treatment protocol. However, due to the potential fatality of uterine necrosis, most treatment options involve total hysterectomy. In our case, only the necrotic tissue of the uterus was removed in young women who had not given birth, and the prognosis for the patient is good. This study also has limitations, including the short follow-up time and the small number of cases collected. It needs to be complemented by subsequent case reports related to uterine necrosis.

Data availability

No datasets were generated or analysed during the current study.

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Yu, T. Minimally invasive treatment of uterine necrosis with favorable outcomes: an uncommon case presentation and literature review. BMC Women's Health 24 , 267 (2024). https://doi.org/10.1186/s12905-024-03089-w

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A giant peripheral ossifying fibroma of the maxilla with extreme difficulty in clinical differentiation from malignancy: a case report and review of the literature

• Ryo Takagi 1 ,
• Kosei Mori 1 ,
• Takashi Koike 1 ,
• Sayumi Tsuyuguchi 1 ,
• Kengo Kanai 1 ,
• Yoshihiro Watanabe 1 ,
• Mitsuhiro Okano 1 ,
• Yoshihiro Noguchi 1 ,
• Aya Tanaka 2 ,
• Kinue Kurihara 2 ,
• Kazumichi Sato 2 ,
• Ken Ishizaki 2 ,
• Yuichiro Hayashi 3 &
• Yorihisa Imanishi   ORCID: orcid.org/0000-0003-0047-7987 1  

Journal of Medical Case Reports volume  18 , Article number:  220 ( 2024 ) Cite this article

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Peripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical irritation. Peripheral ossifying fibroma develops more commonly in young females as a solitary, slow-growing, exophytic nodular mass of the gingiva, no more than 2 cm in diameter. While various synonyms have been used to refer to peripheral ossifying fibroma, very similar names have also been applied to neoplastic diseases that are pathologically distinct from peripheral ossifying fibroma, causing considerable nomenclatural confusion. Herein, we report our experience with an unusual giant peripheral ossifying fibroma with a differential diagnostic challenge in distinguishing it from a malignancy.

Case presentation

A 68-year-old Japanese male was referred to our department with a suspected gingival malignancy presenting with an elastic hard, pedunculated, exophytic mass 60 mm in diameter in the right maxillary gingiva. In addition to computed tomography showing extensive bone destruction in the right maxillary alveolus, positron emission tomography with computed tomography revealed fluorodeoxyglucose hyperaccumulation in the gingival lesion. Although these clinical findings were highly suggestive of malignancy, repeated preoperative biopsies showed no evidence of malignancy. Since even intraoperative frozen histological examination revealed no malignancy, surgical resection was performed in the form of partial maxillectomy for benign disease, followed by thorough curettage of the surrounding granulation tissue and alveolar bone. Histologically, the excised mass consisted primarily of a fibrous component with sparse proliferation of atypical fibroblast-like cells, partly comprising ossification, leading to a final diagnosis of peripheral ossifying fibroma. No relapse was observed at the 10-month follow-up.

Conclusions

The clinical presentation of giant peripheral ossifying fibromas can make the differential diagnosis from malignancy difficult. Proper diagnosis relies on recognition of the characteristic histopathology and identification of the underlying chronic mechanical stimuli, while successful treatment mandates complete excision of the lesion and optimization of oral hygiene. Complicated terminological issues associated with peripheral ossifying fibroma require appropriate interpretation and sufficient awareness of the disease names to avoid diagnostic confusion and provide optimal management.

Peer Review reports

Peripheral ossifying fibroma (POF) is a nonneoplastic inflammatory hyperplasia, that is, a reactive proliferative lesion that arises in the superficial or periapical gingiva, induced by diverse chronic mechanical irritations such as dental calculus, bacterial plaque, orthodontic appliances, ill-fitting crowns and dentures, and improper restorations [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. POF is believed to originate from pluripotent cells of the periodontal ligament or periosteum that can be metaplastically transformed into osteoblasts, cementoblasts, or fibroblasts in response to the aforementioned chronic stimuli [ 1 , 5 , 7 , 9 ]. The histopathology is characterized by fibrous connective tissue with varying numbers of fibroblasts associated with the formation of variable amounts of mineralized products consisting of bone components (woven and lamellar bones), cementum-like material, dystrophic calcification, or a combination thereof [ 1 , 2 , 3 , 4 , 5 , 6 , 8 , 10 ]. Although the immunohistochemical profile of POF has been sparsely documented, spindle-shaped cells in POF have been shown to be positive for smooth muscle actin (SMA) in most cases, suggesting a myofibroblastic nature of the lesion [ 8 , 11 ].

Clinically, POF usually presents as a painless, solitary, slow-growing, relatively well-defined, pedunculated or sessile, exophytic nodular mass of the gingiva [ 2 , 4 , 5 , 6 , 7 , 8 , 9 , 12 , 13 , 14 ]. Epidemiologically, POF develops more commonly in females than in males, mainly during the second to third decades of life, and is predominantly located in the anterior maxilla, especially in the interdental papilla of the incisors [ 1 , 2 , 4 , 5 , 6 , 7 , 8 , 13 ]. Regarding the size, most cases are no more than 2 cm in diameter [ 2 , 5 , 6 , 7 , 8 , 9 , 12 , 13 , 14 , 15 ]; however, very rare cases of POF with unusually marked enlargement (≥ 6 cm) have been reported [ 11 , 16 , 17 , 18 , 19 ], which often require careful differential diagnosis to distinguish them from malignancy.

In clinical practice, there have been nomenclature problems wherein various synonyms have been used to refer to POF, while very similar names also have been applied to neoplastic diseases pathologically distinct from POF, causing considerable confusion among the relevant physicians [ 2 , 4 , 5 , 6 , 10 , 12 , 13 , 20 ].

Here, we report our experience with an unusual giant POF of the maxillary gingiva with a differential diagnostic challenge by reviewing its clinical course and discussing the issues of terminology that should be considered to properly recognize the disease concept of POF.

A 68-year-old Japanese male presented to our department with an exophytic mass on the right side of the maxillary gingiva that appeared 6 months earlier and had rapidly increased in size. He reported that, although he had upper and lower dentures made by a local dentist approximately 3 years ago, he gave up wearing the upper denture after approximately 6 months because it gradually became ill-fitting. His medical history included high blood pressure and hyperuricemia with orally administered regular medications. He smoked 20 cigarettes per day for more than 35 years and drank 500 mL of beer per day on average for more than 35 years.

Intraoral inspection revealed an elastic hard, seemingly well-defined, nonhemorrhagic, and almost pedunculated exophytic mass, approximately 60 mm in maximal diameter, extending medially from the hard palate, posteriorly to the retromolar trigone, and laterally to the buccal mucosa, which surrounded the right maxillary gingiva, including the right upper molars (teeth 16 and 17) (Fig.  1 A, B). The lesion was painless, and its surface appeared superficially multilobulated and slightly roughened, with some erosions and shallow ulcerations. More than half of the permanent teeth were missing in both the upper and lower jaws, resulting in only five healthy teeth (parts of the maxillary incisors, and the mandibular incisors and cuspids) (Fig.  1 C). Cervical palpation found lymphadenopathy of approximately 15 mm in size in the right submandibular region.

Intraoral and panorama-radiographic findings. A and B An elastic hard, seemingly well-defined, pedunculated exophytic tumor-like mass with a maximal diameter of approximately 60 mm was observed surrounding the right upper gingiva, including the right upper molars, extending medially from the hard palate, posteriorly to the retromolar trigone, and laterally to the buccal mucosa. C Orthopantomogram showing that all the remaining molars and premolars, including those surrounded by the right upper gingival mass, had severe alveolar bone resorption, indicating severe chronic periodontitis

An orthopantomogram revealed that, except for the aforementioned healthy teeth, all the remaining molars and premolars, including the molars surrounded by the right upper gingival mass, had severe alveolar bone resorption, indicating that the patient had severe chronic periodontitis (Fig.  1 C). Contrast-enhanced computed tomography (CT) revealed extensive bone destruction on the lateral side of the right maxillary alveolus along the medial side of the mass lesion, together with small calcifications anteriorly within the mass (Fig.  2 A, B). Multiple enlarged lymph nodes, nearly 20 mm in diameter, were also found in the level I–II region of the right side of the neck (Fig.  2 C). Positron emission tomography with CT (PET/CT) revealed noticeable fluorodeoxyglucose (FDG) accumulation (maximum standardized uptake value [SUVmax] 14.81) in the area consistent with the right maxillary gingival mass containing chronic periodontitis (Fig.  2 D, E), whereas the right cervical level I–II lymph nodes showed only a relatively mild increase in FDG accumulation (Fig.  2 F).

CT and PET/CT findings. A – C CT image showing a marked bone destruction-like defect on the lateral side of the right maxillary alveolus (arrowhead, A ) contiguous with the right maxillary gingival mass lesion (arrows, A and B ), along with small calcifications (arrowhead, B ) anteriorly within the mass. Multiple enlarged lymph nodes, nearly 20 mm in length, were observed in the level I–II region of the right side of the neck (arrows, C ). D – F PET/CT scan demonstrating FDG hyperaccumulation (SUVmax = 14.81) in the right maxilla in an area consistent with the gingival lesion containing chronic periodontitis ( D and E ). Only mild FDG accumulation was observed in the cervical lymph nodes (arrows, F )

Initial biopsy was performed from the palatal and buccal sides of the surface of the mass, both of which showed “granulation tissue associated with marked inflammatory cell infiltration.” Because the imaging findings suggested a high probability of malignancy, a second biopsy was performed deeper into the lesion; however, the histology showed “severe chronic inflammatory cell infiltration and fibrous connective tissue hyperplasia with some bone tissue involvement,” again with no malignancy. Although pancytokeratin immunostaining was performed, no atypical epithelial cells were observed. At this stage, we additionally considered the possibility of reactive hyperplastic lesions [ 3 , 4 ] on the gingiva as a differential diagnosis; however, the possibility of malignancy could not be excluded as a pretreatment diagnosis in light of the above-mentioned findings.

Since surgical resection appeared indispensable regardless of the exact diagnosis, the patient underwent surgery under general anesthesia as a treatment that also served as a definitive diagnosis. Prior to surgery, the aforementioned inactive teeth with severe chronic periodontitis, except for the right maxillary molars contiguous with the lesion, were extracted by a dentist. During surgery, first of all, the two remaining right upper molars and one premolar surrounded by the gingival mass were extracted (Fig.  3 A). Then, several small specimens of the mass were excised from the tissue around the extraction socket corresponding to the deepest portion of the lesion and subjected to intraoperative frozen histological examination. Like the preoperative histological findings, all biopsied specimens showed “inflammatory granulation tissue with fibrosis and small calcification” without any malignancy, leading to a provisional diagnosis of ruling out the possibility of malignancy. Accordingly, we decided to perform a procedure similar to partial maxillectomy for benign lesions with minimal resection margins and omitted neck dissection.

Intraoperative findings. A Preoperative appearance of the right maxillary gingival mass lesion. B Intraoperative view after resection of the pedunculated gingival mass. The base of the mass was almost confined to the gingival mucosa. The remaining granulation tissues around the resection margin and surrounding alveolar bone were thoroughly curetted (arrow: preserved mucosa elevated from the alveolar bone). C The wound surface was covered by a polyglycolic acid sheet with fibrin glue. D Following additional covering with a sheet of chitin (poly- N -acetylglucosamine)-coated gauze (arrow), an immediate surgical obturator (ISO; arrowhead, transparent in color) was placed

As resection proceeded, the base of the pedunculated mass was found to be almost confined to the gingival mucosal surface, with the surrounding mucosa remaining normal. After removing the main mass, sufficient detachment and elevation of the surrounding normal mucosa from the periosteum were followed by thorough curettage of the remaining granulation tissues around the resection margin (Fig.  3 B). The alveolar bone was sufficiently shaved until a healthy bone margin was exposed, with additional scraping of the sharp edges. Although the bone defect in the maxillary sinus floor extended to approximately 10 mm, the sinus mucosa was preserved without perforation. After meticulous hemostasis, the wound surface was covered by a polyglycolic acid sheet (NEOVEIL Nano Ⓡ D10, Gunze Medical, Japan) with fibrin glue (Fig.  3 C) and then with a sheet of chitin (poly- N -acetylglucosamine)-coated gauze. An immediate surgical obturator (ISO), premade by the dentist, was placed immediately after surgery (Fig.  3 D). The excised mass was partially lobulated and measured approximately 60 × 36 × 17 mm (Fig.  4 A).

Histopathological findings. A The excised mass was partially lobulated and measured approximately 60 × 36 × 17 mm. B – D Hematoxylin and eosin staining. The histology consisted primarily of a fibrous component with myxoid degeneration and sparse proliferation of atypical fibroblast-like cells ( B ), partly comprising cementum-like ossification and calcification ( C ), without any atypia, even in the superficial squamous epithelium ( D ), leading to a final diagnosis of POF

The histology of the excised mass consisted primarily of a fibrous component with myxoid degeneration and sparse proliferation of atypical fibroblast-like spindle-shaped cells (Fig.  4 B), partly comprising cementum-like ossification and calcification (Fig.  4 C). No atypia was observed, even in the superficial squamous epithelium (Fig.  4 D). Immunostaining revealed mild positivity for SMA in the spindle-shaped cells, whereas S100, desmin, and CD34 were negative. Pancytokeratin staining, for which a positive is suggestive of odontogenic epithelium, was also negative. Based on these histological findings, a final diagnosis of POF was made.

The surgical wound healed uneventfully with granulation and reepithelialization, thereby maintaining the shape of the alveolar ridge. Three months after surgery, the patient regained the ability to consume a regular diet with the help of dentures remade by the dentist. No relapse or other complications were observed at the 10-month postoperative follow-up (Fig.  5 ).

Comparison between pre- and postoperative findings. A and B Right maxillary gingival lesion site preoperatively ( A ) and 3 months postoperatively ( B ). C and D Coronal CT images preoperatively ( C arrow: POF lesion) and 4 months postoperatively ( D a fistula due to the bone defect of the maxillary sinus floor closed spontaneously)

We reviewed the POF case series previously reported in various countries and summarized the epidemiological and clinical features (sex, age, site of occurrence, and size) of POF in Table  1 [ 2 , 4 , 6 , 7 , 8 , 9 , 14 , 15 , 21 ]. There were sex differences with consistent female dominance, except in one report [ 7 ], wherein the female-to-male ratio varied substantially, ranging from 1.3 to 3.5. The second to fourth decades of life were common susceptible ages, with 30s being the average age, and a gradual declining trend in the ratio with aging after 40 years was apparent in large-scale reports [ 4 , 14 ]. While the occurrence sites were distributed entirely across the upper and lower gingiva, the majority of studies indicated that the anterior maxilla (incisors and cuspids) was the most common site [ 2 , 4 , 6 , 9 , 14 , 21 ]. While the size of lesions ranged quite widely, most studies have reported an average size of 1–2 cm [ 2 , 6 , 8 , 14 , 15 ] and a maximum diameter of no more than 3 cm [ 2 , 9 , 15 , 21 ] or 5 cm [ 6 , 8 ] (except for a report with unknown data [ 4 ]).

The patient in this report was relatively “elderly” (68 years old) and male, with the lesion located on “the posterior maxilla”; although self-reported, the mass “had grown rapidly to over 6 cm in diameter within 6 months of its initial appearance,” all of which appeared unusual for a POF. In addition, because of the patient’s substantial history of smoking, alcohol consumption, and extremely poor oral hygiene, malignancy was strongly suspected. After treatment, when asked about the history of denture use in detail, the patient told us that, although he had quit using his upper denture due to ill-fitting, he continued to wear only his lower denture for more than 2 years to avoid eating difficulties. Accordingly, inappropriate denture use habits, in which the lower denture provided unnatural chronic mechanical stimulation to the maxillary gingiva during mastication, were suggested to be critical triggering factors for POF development. However, even if we had been aware of this episode from the beginning, there would not have been sufficient evidence to rule out malignancy before treatment.

Regarding the imaging findings of POF, the identification of radiopaque calcified foci via X-ray or CT is likely helpful in differential diagnosis; however, its sensitivity is not sufficient because the amount of calcified tissue varies depending on the patient [ 5 , 7 ]. Although the preexisting bone structure seldom changes except for compression-associated superficial concave defects and occasional tooth displacement, lesions that have increased in size over time may occasionally present with erosion or even destruction of the bone surface [ 6 , 7 , 9 ]. In the present case, the orthopantomogram showed no radiopaque calcified foci within the lesion, whereas CT displayed a very small number of calcified components in a limited portion of the lesion. However, its small size was not highly indicative of POF, even in hindsight. The marked bone destruction of the maxillary alveolus adjacent to the lesion shown on CT, together with the hyperaccumulation of FDG revealed on PET/CT, appeared to be rather more suggestive of malignancy. In contrast, the findings of preoperative tissue biopsies were, as it turns out, all consistent with POF. Considering that small bone fragments (cementum-like ossification) were contained within the lesion in the second biopsy obtained from a deeper location, it might have been possible to provisionally rule out malignancy at this stage, depending on the degree of experience. However, because of the many unusual features of POF, in terms of its size, clinical course, epidemiological background, and imaging findings suggestive of malignancy, it seemed practically difficult to exclude the possibility of malignancy on the basis of the preoperative examination alone.

In a review of reports of giant cases of POF (consisting of ten cases measuring 2.5 cm or larger) [ 22 ], although most required discrimination from malignancy, the proportion of cases with local bone resorption and that of cases with tooth displacement within the lesion were both at most half, suggesting that we should recognize the difficulty of pretreatment differential diagnosis in such giant POFs, as experienced in the present case. Regarding the differential diagnosis from other inflammatory proliferative lesions of the gingiva, peripheral giant cell granuloma (PGCG) is most similar to POF in that it is a reactive lesion that originates exclusively in the periodontal ligament or periosteum of the gingiva [ 4 ]. PGCG can be distinguished from POF by its common development in females between the fourth and sixth decades of life, its presentation as a relatively soft nodular mass, and its histological features consisting of a proliferation of mesenchymal cells and multinucleated giant cells associated with prominent vascular growth [ 4 , 9 , 23 ]. However, approximately one-third of PGCG also contains bone components [ 4 , 23 ], indicating that caution is still needed to distinguish them from each other.

Although conservative local resection is the standard treatment for POF, complete excision of the lesion, including the adjacent periodontal ligament or periosteum where the POF originates, as well as removal of the source of the irritating stimuli, are essential to eliminate the chances of recurrence [ 2 , 6 , 8 , 9 , 14 ]. In the present case, since no malignancy was reported even on intraoperative histological examination, the resection margin was determined to be as minimal as necessary in accordance with benign tumors. However, to eradicate the possible residual lesions, additional shaving and scraping of the alveolar portion of the maxilla were performed beyond the depth at which the healthy bone was exposed.

Through our experience with this case, we undeniably recognized three possible pitfalls associated with the terminology of POF that should be noted when correctly diagnosing POF and better understanding its pathogenesis. First, the disease conventionally referred to as “ossifying fibroma” means a benign tumor of bone origin whose pathogenesis is entirely different from that of POF. The origin of ossifying fibroma is the periodontal ligament (which is in common with POF) or endosteum (a very thin connective tissue layer covering the bone marrow cavity inside the bone cortex), which principally expands into the medullary space of the bone [ 3 , 6 , 7 , 12 ]. Since ossifying fibroma is sometimes referred to as “central ossifying fibroma” (COF) when it needs to be clearly distinguished from POF, it should be noted that the terms “central” versus “peripheral” in this context are employed simply in the sense of indicating their positional relationship in the bone structure [ 13 ]. Furthermore, the term “ossifying fibroma” can be referred to in multiple senses (in both broad and narrow senses); it is generally used in the narrow sense to refer to COF, whereas it is sometimes used in the broad sense as an umbrella term for both COF and POF, making the interpretation of this term quite confusing and ambiguous, which requires us to carefully distinguish the meaning indicated by the term depending on the situation [ 6 , 13 ].

Second, a multitude of synonyms have been used in the nomenclature of POF. Those seen in previous papers are as follows: “peripheral cemento-ossifying fibroma,” “ossifying fibro-epithelial polyp,” “peripheral fibroma with osteogenesis,” “peripheral fibroma with cementogenesis,” “peripheral fibroma with calcification,” “calcifying or ossifying fibroma epulis,” “calcifying fibroblastic granuloma,” “ossifying fibrous epulis,” “peripheral cementifying fibroma,” “calcifying fibroma,” “calcified peripheral fibroma,” and “calcified or ossified fibrous granuloma” [ 2 , 5 , 6 , 7 , 9 , 10 , 13 , 14 ]. Most appear to be a combination of terms meaning “ossification” or “calcification,” and “fibroma” or “fibrous.” However, numerous different names used for the identical pathological condition have led to a considerable degree of confusion in clinical practice [ 4 , 5 , 6 , 10 , 13 ], which appears to be the decisive factor in preventing the spread of accurate recognition of POF. Fortunately, in recent years, a consensus has emerged regarding the use of “peripheral ossifying fibroma (POF)” as the English term for this pathological condition, although a few exceptions remain. Furthermore, since the term “fibroma” literally refers to “benign tumor of fibrous connective tissue origin,” nomenclature-wise, the naming of POF (peripheral ossifying fibroma) itself is undoubtedly a misnomer for the inflammatory reactive proliferative lesion. However, revising its designation at this stage seems rather unwise, as it would have a much greater disadvantage of causing additional unnecessary confusion.

Third, POF should also be distinguished from “peripheral odontogenic fibroma,” a different disease for which the same abbreviation “POF” has been applied [ 12 , 20 ]. Odontogenic fibroma is classified as one of benign mesenchymal odontogenic tumors in the World Health Organization (WHO) classification, which is further divided into endosteal “central odontogenic fibroma” and extraosseous “peripheral odontogenic fibroma” according to their position in the bone structure; both of these conditions are thus entirely different from POF [ 2 , 13 ]. The distinction between peripheral ossifying fibroma, an inflammatory reactive proliferative lesion, and peripheral odontogenic fibroma, a benign tumor, is quite misleading because they share the same abbreviation, “POF,” which requires caution to not confuse them.

Although POF is an inflammatory reactive proliferative lesion, its extreme enlargement can cause alveolar bone destruction and hyperaccumulation of FDG on PET/CT, making the differential diagnosis from gingival malignancy difficult. Proper diagnosis relies on the recognition of its characteristic histopathological findings and identification of possible underlying chronic mechanical stimuli, while successful treatment mandates complete resection of the lesion and improvement of problematic oral hygiene. Due to the numerous synonyms for POF and coexistence of very similar names for different neoplastic diseases, appropriate interpretation and sufficient awareness of these disease names are required to avoid diagnostic confusion and provide optimal management.

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The collected data and materials that can identify the patient are not publicly available because of the adequate protection of patient privacy. All other data collected and analyzed during this case study are included in this published article.

Abbreviations

Central ossifying fibroma

Computed tomography

Fluorodeoxyglucose

Immediate surgical obturator

Positron emission tomography with computed tomography

Peripheral giant cell granuloma

• Peripheral ossifying fibroma

Smooth muscle actin

Standardized uptake value

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We would like to thank Editage ( www.editage.com ) for English language editing.

This work was supported in part by a Grant-in-Aid for Scientific Research (C) from The Japan Society for the Promotion of Science (23K08918).

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Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan

Ryo Takagi, Kosei Mori, Takashi Koike, Sayumi Tsuyuguchi, Kengo Kanai, Yoshihiro Watanabe, Mitsuhiro Okano, Yoshihiro Noguchi & Yorihisa Imanishi

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Aya Tanaka, Kinue Kurihara, Kazumichi Sato & Ken Ishizaki

Department of Pathology, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan

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RT treated the patient, collected and analyzed the materials and data, and drafted the manuscript. KM, TK, ST, KKa, and YW helped manage the patient and supported the data interpretation. AT, KKu, and KS treated and managed the patient in their capacity as dentists and oral surgeons. MO, YN, and KI provided helpful advice and administrative support. YH made the pathological diagnosis and provided critical suggestions. YI treated and managed the patient, organized the materials and data, and wrote and revised the manuscript. All the authors have read and approved the final manuscript.

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Takagi, R., Mori, K., Koike, T. et al. A giant peripheral ossifying fibroma of the maxilla with extreme difficulty in clinical differentiation from malignancy: a case report and review of the literature. J Med Case Reports 18 , 220 (2024). https://doi.org/10.1186/s13256-024-04529-9

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Received : 29 February 2024

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DOI : https://doi.org/10.1186/s13256-024-04529-9

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• Reactive proliferative lesion
• Ossification
• Periodontal ligament
• Differential diagnosis
• Terminology

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